NO VIRTUE IN TINKERING WITH HMOS

It is not every day that this knee-jerk centrist gets to drag out the famous Barry Goldwater quote and say "yeah." But the subject is the takeover of the American medical system by managed-care companies. The public is very angry at the results. Moderates of both parties have responded with legislation aiming to tame the HMO beast.

Much better ideas, however, are coming from farther left and farther right. How ironic that the government-run health-insurance system favored by liberals and the conservatives' Medical Savings Account would achieve the same worthy goals. They would de-link health coverage from place of employment. They would restore the patient's right to choose care givers.

Bills now circulating around Washington seek to tighten the screws on managed-care companies rather than deal them out of the game. They would require HMOs to reveal information on costs, benefits and quality of care. They would insist on emergency-room coverage for people who believe they are in medical crisis. Senate Democrats also want to give patients the right to sue their insurance companies for denying necessary care.

None of these proposals is bad.

The problem with these sensible-sounding measures is that they are based on a rotten assumption _ that it's OK for insurance companies to be running our medical system.

In just a few short years, managed-care companies have wrested from consumers the right to pick their doctors, to use the most convenient X-ray lab, to get medication that may cost a few extra dollars but has fewer side effects. Doctors have been shorn of their ability to spend extra time with patients who need extra time, to suggest expensive treatments they deem superior, to send patients to specialists they respect. All the while, more than 40 million Americans lack any health coverage.

No serious politician would suggest going back to the old fee-for-service days when doctors could order as many treatments, tests and expensive procedures as they wished. Insurance companies would passively pay the bills, then raise premiums for employers who provide health coverage. But how about the third ways being suggested by our true liberals and serious conservatives?

This writer prefers a national health plan in which Washington collects the insurance money and pays set fees for medical services (much like Medicare). Everyone is covered. Doctors continue to work for themselves and benefit from greatly reduced paper work. Patients may choose their doctors. They may not get everything they want, but no one is paid a bonus for denying proper care. If Americans want something fancier than a Canadian-style single-payer system, they could opt for the multi-payer kind of setup that is found in France and Germany. There, a government insurance program provides the basics but consumers can buy extra insurance with more bells and whistles.

The conservatives' idea of replacing managed care with Medical Savings Accounts comes in second, but it would still be a great improvement over what we have. Under that program, individuals could put money into tax-sheltered savings accounts dedicated to medical care. They would withdraw funds to pay for ordinary expenses, such as checkups, allergy shots or blood tests. Since they are spending their own money, consumers would have strong incentives to spend it wisely. The account would include an old-fashioned insurance policy to cover catastrophic illness requiring expensive treatment, such as chemotherapy or organ transplants.

Legislators who think widespread displeasure with HMOs can be cured by making managed-care companies nicer happen to be supporting a radical status quo. When lawmakers have to force insurers to allow a woman undergoing a double mastectomy at least one night in a hospital, something basic is wrong. When Americans must call a lawyer before they can get the chemotherapy treatment their doctor urges, that's crazy. When we must pass laws forbidding insurers to penalize doctors for telling patients about available treatments, then we are no longer free people. Profit-oriented managed care is flawed at the core. Let's just dump it.